title: Routine surveillance ultrasound for the management of central venous catheters in neonates.
abstract: OBJECTIVE
  To evaluate the frequency of central venous catheter (CVC)-related thrombi detected by routine surveillance ultrasound, and to assess whether positive findings had an impact on management or outcomes.
  
  
  METHODS
  All neonates in a tertiary neonatal intensive care unit who had a CVC inserted for >14 days underwent routine surveillance ultrasound biweekly between January 2003 and December 2009. Data were reviewed retrospectively.
  
  
  RESULTS
  Although all neonates were asymptomatic at time of surveillance ultrasound, 645 of the total 1333 CVCs inserted in 1012 neonates underwent surveillance ultrasound, and thrombi were detected in 69 (10.7%). The CVCs with thrombi were more likely to be removed for nonelective reasons compared with CVCs without thrombi (59% vs 38%; P = .001; OR, 2.4, 95% CI 1.4-3.9). A total of 955 surveillance ultrasounds were performed to detect and monitor 69 CVCs with thrombi. The majority of thrombi were nonocclusive and nonprogressive. A change in management occurred in 8 cases of CVC-related thrombi (12%), or 1% of all screened cases. An average of 14 ultrasounds were required to detect and monitor 1 CVC with thrombus, at a cost of $951 per CVC with thrombus and $8106 per case of CVC-related thrombi with a change in treatment.
  
  
  CONCLUSIONS
  Asymptomatic thrombi were detected in a significant proportion of CVCs by routine surveillance ultrasound. There were significant costs, but infrequent changes to patient management.
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Habib
authors.initials: H
authors.lastname: Haddad
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kyong-Soon
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Division of Hematology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ann
authors.initials: A
authors.lastname: Higgins
authors.affiliation: Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Douglas
authors.initials: D
authors.lastname: McMillan
authors.affiliation: Division of Hematology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Victoria
authors.initials: V
authors.lastname: Price
authors.affiliation: Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: walid.el-naggar@iwk.nshealth.ca.
authors.forename: Walid
authors.initials: W
authors.lastname: El-Naggar
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods*; D062905:Central Venous Catheters; D003120:Colorado / Q000453:epidemiology; D003428:Cross Infection / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology
keywords: CVC; Central venous catheter; IWK; Izaak Walton Killiam; NICU; Neonatal intensive care unit